Why do UK military personnel refuse the anthrax vaccination?

The purpose of this study was to understand the reasons why some UK military personnel refused the anthrax vaccination. Data were collected from 5,302 members of the UK Armed Forces who had been deployed to Iraq since 2003 and had been offered the anthrax vaccination. As part of a larger questionnaire, information was collected on acceptance or refusal of the vaccination. Twenty-eight percent of participants refused the anthrax vaccination; of these 51% indicated that they refused vaccination because of concern that it was being offered voluntarily. Reasons differed between those deployed during the war-fighting phase in Iraq, who were concerned about being supplied with insufficient or unclear information (75% vs. 66%), and those involved on subsequent deployments, who felt that there was no longer a risk that biological weapons would be used against them (61% vs. 43%). Thus, refusal rates were related to perception of the threat. In addition, our results indicated the importance of providing individuals with relevant information to aid them in making decisions to receive the anthrax vaccination or not. The findings provide evidence that for some people, the policy to increase confidence in the anthrax vaccination program may have led to a decrease in levels of trust.     

The use of interviews with surrogate respondents in a case-control study of oral cancer

The purpose of this study was to assess the possible bias that may occur in case-control studies when exposure information is not collected from all potentially eligible cases. The data used in this study were collected in the metropolitan area of Atlanta as part of a multicenter, population-based, case-control study of oropharyngeal cancer. In-person interviews were conducted with 112 cases (67.9 percent) and information on an additional 23 ill or deceased cases (13.9 percent) was collected through surrogate respondents. The cases about whom information was collected from surrogate respondents had more advanced disease at the time of diagnosis and were more likely to be black and less educated than cases who were interviewed in person. Cigarette smoking and consumption of hard liquor were more common among the cases about whom information was collected through surrogates. Therefore, failure to include such information would have resulted in underestimates of the strength of association between these exposures and the risk of oropharyngeal cancer.     

Satisfaction with breast reconstruction in women with bilateral prophylactic mastectomy: a descriptive study

Prophylactic bilateral mastectomy is an option for women who are at an increased risk of developing breast cancer. Prophylactic mastectomy is often performed with immediate reconstruction (i.e., at the same time and under the same anesthetic as the mastectomy). Satisfaction with reconstruction has been described previously for women with mastectomy for breast cancer. However, the authors know of no previous research that has reported on satisfaction with reconstruction in patients who have electively sought mastectomy for the prevention of breast cancer. Women in the province of Ontario who had undergone prophylactic bilateral mastectomy plus breast reconstruction between 1991 and 2000 were asked to rate their level of satisfaction with the cosmetic results of their mastectomy and reconstruction and their overall satisfaction with their decision to have prophylactic mastectomy. Women were also asked whether they experienced complications associated with their surgery and what types of complications they experienced. Thirty-seven women completed questionnaires for this study, and all of them had immediate breast reconstruction after prophylactic mastectomy. The majority of women (70.3 percent) reported being satisfied or extremely satisfied with the cosmetic results of their breast reconstruction. Women with self-reported postsurgical complications (16.2 percent) were significantly less satisfied with reconstruction than those who did not report complications (p = 0.009). Personal subjective risk of breast cancer before prophylactic mastectomy was negatively correlated with satisfaction with reconstruction (r = -0.38, p = 0.024) and with subjective risk estimation after prophylactic surgery (r = -0.54, p = 0.001). Women who did not worry about developing breast cancer after prophylactic mastectomy had significantly higher levels of satisfaction with breast reconstruction than those who continued to worry (p < 0.001). Women who reported an improved body image after reconstruction were significantly more likely to report higher levels of satisfaction than those who reported a diminished body image (p = 0.007). The majority of women were satisfied with the cosmetic results of breast reconstruction after prophylactic mastectomy. Women who overestimated their breast cancer risk had lower satisfaction levels. Correcting overestimation of breast cancer risk in women who have prophylactic mastectomy may improve satisfaction with reconstruction following prophylactic mastectomy.     

Pregnancy wantedness: attitude stability over time

In this analysis we have compared two attitudinal reports, from interviews two years apart, of the same event for consistency over time. We have looked at women's self-reports, and at their proxy reports for partners' attitudes as well. The inconsistent reports of women's own views tended to shift slightly toward more favorable reports at the second interview (15 percent more positive versus 10 percent more negative). More specifically, 7.5 percent of women who reported at Time 1 that their most recent births had been unwanted switched to more favorable reports at Time 2, and about the same percentage of women who reported Table 4, the findings would suggest that some of the groups typically considered to be most "at risk" were those who were also most apt to report inconsistently. This findings should signal some concern in the policy community. Net of other factors, there is no effect of income, but a number of at-risk groups remained significantly more likely than others to change their reports over time. Of particular concern is the finding that women who reported their pregnancies as mistimed or unwanted were so much more likely to change their reports over time than were women who initially said that their pregnancies had been well timed. When we look at the direction of change, it is clear that, with some exceptions, the more "at risk" groups were more likely to shift in a more negative direction, while the less "at risk" groups were less likely to do so; and at times they were more likely to report more favorably at the second interview. Although somewhat hampered by small sample sizes in the analysis of Time 1 mistimed and unwanted reports, results confirmed that certain subgroups were not only more apt to report inconsistently, they were also more likely to do so in specific directions. To the extent that future survey questions can emphasize to respondents that they should focus on the time of conception, and not on current status, inconsistency across groups may be reduced.     

Sexual behaviour, contraceptive practice and knowledge of AIDS of Oxford University students

In 1987, a questionnaire was sent to 584 undergraduate students at Oxford University requesting information about their sexual behavior and contraceptive practices as well as the impact of acquired immunodeficiency syndrome (AIDS) on both these factors. Of the 374 responders, 65% of the women and 62% of the men had experienced sexual intercourse; 1st intercourse had occurred at ages 16-20 years for 89% of the experienced women and 83% of the men. For 36% of women and 37% of men intercourse had been with 1 partner only, for 28% of women and 27% of men with 2-3 partners, and for 36% of both men and women with more than 3 partners. 27% of the women reported no contraceptive was used at the time of 1st intercourse. During the 4 weeks preceding completion of the questionnaire, 15% of sexually active female undergraduates reported not using adequate contraception. Users during this period selected the pill (64%), condom (19%), IUD or diaphragm (9%), or withdrawal/rhythm (8%). General knowledge about AIDS was highly accurate among these students. Most students considered themselves to be at lower risk of contracting AIDS than others of their age and sex. Of the 78% of students describing themselves as at lower than average risk, 14% had had intercourse with more than 3 partners, while 50% of the 20% of students who ranked themselves as at average risk had this number of partners. Only 2% placed themselves as at above average risk, and 65% of these students had had more than 3 sexual partners. Of students who were sexually active, 35% of the females and 44% of the males indicated they are now more likely to use a condom because of fear of AIDS. 49% of the females and 30% of the males indicated they had, or would have, fewer sexual partners because of the AIDS risk. However, there was no association between increased likelihood of condom use and the total number of sexual partners and having had intercourse with someone in a high-risk group for AIDS (prostitutes). Overall, however, these findings suggest that the AIDS threat is producing reductions in high-risk behaviors.     

No news is bad news: patients' views about communication in hospital.

One hundred patients on four general surgical wards in a large teaching hospital were interviewed about the information they had received about their illness and what they had been told about the investigations they had undergone. Fifty-five of them expressed some dissatisfaction and 14 were strongly dissatisfied. The way in which ward rounds were conducted was heavily criticised, but most patients did not object to the teaching of medical students at the bedside. Twenty-four patients would have liked more explanation about why investigations were performed, and 38 though that they had not been told enough about the results of their investigations. This lack of information led to anxiety and fear. The findings suggest that more effort is needed to improve communication between doctors and patients.     

Knowledge and Experience Predict Indiscriminate Bat‐Killing Intentions among Costa Rican Men

Human–wildlife conflicts create collateral damage when people attempt to control one problematic species and inadvertently kill others. I observed a collateral damage problem in southern Costa where people seeking to control common vampire bats (Desmodus rotundus) indiscriminately killed sympatric, non‐target bat species (e.g., by baiting bats with poisoned bananas). To learn about this phenomenon and its causes, I developed and implemented a questionnaire based on the theory of planned behavior. In a sample of 504 men, 14 percent had individually killed 1–115 bats within the past 5 yr, 68 percent had killed bats as children, and 27 percent said that they would kill bats that they found roosting on their farms, even if they could not identify the species. Men who intended to indiscriminately kill bats thought that it would reduce disease transmission to livestock, whereas men who did not intend to kill bats thought that killing bats would reduce ecosystem functioning and/or damage nature. Ultimately, men were more likely to intend to indiscriminately kill bats if they knew less about bat natural history and/or had previously suffered vampire bats attacking their livestock. Men knew more about bat natural history and were less likely to harbor indiscriminate bat‐killing intentions if they had experienced some form of environmental education. My results suggest that environmental education will be most effective for bat conservation when combined with farmer support to ameliorate perceived livelihood risks associated with vampire bats.     

Women who wish breast reconstruction: characteristics,fears, and hopes

The aims of the present study were to identify the characteristics of a consecutive series of women with newly diagnosed breast cancer and to evaluate the perceived benefits and disadvantages of breast reconstruction. A consecutive series of 125 women completed the Breast Reconstruction Questionnaire, the Hospital Anxiety and Depression Scale, and the Eysenck Personality Questionnaire. The median age was 48 years (range, 28 to 75 years). A total of 49.6 percent (n = 62) indicated that, if it were possible, they would like breast reconstruction. Logistic regression (simultaneous entry) revealed that younger women (p = 0.0001) and more depressed women (p = 0.026) were more likely to wish reconstruction. Marital status, tumor size, extroversion, neuroticism, and tough-mindedness did not independently predict the desire for reconstruction. If given a choice of reconstruction at 3 months or 6 months after mastectomy, of the women who wished reconstruction, 74 percent would prefer it at 3 months. Of the women who wished reconstruction and expressed a preference, 63 percent were afraid reconstruction might mask recurrence, 39 percent were afraid that reconstruction might cause the cancer to return, and 89 percent thought they would be concerned with their appearance after the operation. Positively, 94 percent considered that reconstruction would be beneficial in terms of their self-esteem, 86 percent indicated that reconstruction would give greater freedom to wear any clothing, and 86 percent thought that the cosmetic appearance of breast reconstruction was better than that of a prosthesis. Concerns about recurrence were common. A better understanding of the concerns of women with regard to reconstruction would allow more informed preoperative discussion.     

Hendra Virus and Horse Owners – Risk Perception and Management

Hendra virus is a highly pathogenic novel paramyxovirus causing sporadic fatal infection in horses and humans in Australia. Species of fruit-bats (genus Pteropus), commonly known as flying-foxes, are the natural host of the virus. We undertook a survey of horse owners in the states of Queensland and New South Wales, Australia to assess the level of adoption of recommended risk management strategies and to identify impediments to adoption. Survey questionnaires were completed by 1431 respondents from the target states, and from a spectrum of industry sectors. Hendra virus knowledge varied with sector, but was generally limited, with only 13% of respondents rating their level of knowledge as high or very high. The majority of respondents (63%) had seen their state’s Hendra virus information for horse owners, and a similar proportion found the information useful. Fifty-six percent of respondents thought it moderately, very or extremely likely that a Hendra virus case could occur in their area, yet only 37% said they would consider Hendra virus if their horse was sick. Only 13% of respondents stabled their horses overnight, although another 24% said it would be easy or very easy to do so, but hadn’t done so. Only 13% and 15% of respondents respectively had horse feed bins and water points under solid cover. Responses varied significantly with state, likely reflecting different Hendra virus history. The survey identified inconsistent awareness and/or adoption of available knowledge, confusion in relation to Hendra virus risk perception, with both over-and under-estimation of true risk, and lag in the uptake of recommended risk minimisation strategies, even when these were readily implementable. However, we also identified frustration and potential alienation by horse owners who found the recommended strategies impractical, onerous and prohibitively expensive. The insights gained from this survey have broader application to other complex risk-management scenarios.     

Seven-year follow-up of heroin addicts: abstinence and continued use compared.

Data from a seven-year follow-up study of drug addicts were examined to see whether there were any differences between those who had stopped using opiates and those who had continued to use them. Information about the addicts when they first entered the study in 1969 was also reviewed to determine whether any of their characteristics would have predicted whether they would stop using opiates or continue. Those who had stopped using opiates by 1976-7 were more likely than the continuing addicts to have a job and legitimate source of income, to be in good health, and to have a stable address and less likely to have problems with the law or contact with addicts. In 1969, however, there were few differences between those who eventually stopped using drugs and those who continued, though the former group were younger, had a shorter period of heroin use, and had worked less since they became addicted. Over the seven years'' follow-up the addicts who stopped taking drugs changed most, while those who stayed on opiates changed their life-style very little.     

Reasons why mastectomy patients do not have breast reconstruction

Breast reconstruction after mastectomy is valuable, yet only a small percentage of eligible patients ever have reconstruction. Little has been done to determine why so few patients proceed with reconstructive surgery. A homogeneous population of mastectomy patients, some of whom underwent breast reconstruction while others did not, were surveyed regarding their attitudes about breast reconstruction. A total of 245 women were surveyed. One-hundred and fifty-eight (64 percent) responded, 71 of whom had been reconstructed while 87 had not. Comparison of the responses of the two groups suggests factors that play a role in determining whether the mastectomy patient will accept or decline the option of breast reconstruction. Considerations that made it less likely that a woman would pursue reconstruction included advanced age at the time of mastectomy, concern about complications from further surgery, uncertainty about outcome, and fear about the effect of reconstruction on future problems with breast cancer. Marital status, receiving chemotherapy, or knowing a patient who had a bad result from reconstruction did not affect the decision. An awareness and understanding of these factors may be helpful to physicians in counseling patients and in increasing the number of women who enjoy the benefits of breast reconstruction.     

Rhesus Macaques (Macaca mulatta) Use Posture to Assess Level of Threat From Snakes

Once prey animals have detected predators, they must make decisions about how to respond based on a cost‐benefit analysis of their risk level. The threat sensitivity hypothesis predicts that prey animals match their response to the level of risk, with high‐risk predator encounters eliciting stronger evasive responses than low‐risk encounters. Primates are known prey of snakes, yet they vary their responses toward snakes. We predicted that primates match their response to the threat level from snakes by assessing posture, with striking postures indicating greater risk than coiled postures and coiled postures indicating greater risk than extended sinusoidal postures. We tested this prediction in a series of experimental trials in which captive rhesus macaques (Macaca mulatta) were exposed to snake models in those postures. Results supported the predictions: macaques responded more strongly to a snake model in a striking posture than in a coiled posture and more to a snake model in a coiled posture than to an extended sinusoidal snake model. We also examined responses of macaques to a partially exposed snake model to mimic the condition of incomplete information, as snakes are often occluded by vegetation. The occluded snake model evoked a response comparable to that of the striking snake. These findings support the threat sensitivity hypothesis. Rhesus macaques use the posture of snakes as a cue in threat assessment, responding more intensely as threat increases, and they also behave as if risk is elevated when their information about snakes is incomplete.     

Breast cancer found at the time of breast reduction.

In a recent study involving 27,500 women who had breast reduction surgery in Ontario, Canada, 17 women who were diagnosed as having breast cancer at the time of their breast reduction surgery were identified. The aims of this study were to (1) describe a population-based series of patients who had breast cancer diagnosed at the time of breast reduction, (2) describe the treatment of these cancers, and (3) compare their survival rate with survival in patients in the general population who had breast cancer. Information about these women, their treatment, and outcome was extracted from hospital records, pathology reports, and reports from regional cancer centers. The chance of finding an invasive breast cancer at the time of breast reduction was 0.06 percent, which is lower than what has been reported previously. Sixty-seven percent of these women were treated with total mastectomy. In the remaining 33 percent, who were treated with partial mastectomy, the entire tumor was removed at the time of breast reduction. Fifty percent of the women were treated with radiation, and 25 percent were treated with chemotherapy or hormonal therapy. Compared with women in the general population of Ontario who have breast cancer, women whose breast cancer is discovered during breast reduction surgery are more likely to be treated with complete mastectomy and less likely to be treated with radiotherapy or chemotherapy. Seventy-one percent of the breast reduction group were axillary node-negative at diagnosis, compared with 58 percent in the general population of women with breast cancer. Survival from breast cancer in women diagnosed at the time of breast reduction (88 percent, 5-year survival) was better than survival from breast cancer in the general population (77 percent). These findings suggest that cancers found in women at the time of breast reduction are less advanced, possibly because they are diagnosed at an earlier stage.     

A report from Japan: choices of Japanese patients in the face of disagreement

Background: Patients in different countries have different attitudes toward self-determination and medical information. Little is known how much respect Japanese patients feel should be given for their wishes about medical care and for medical information, and what choices they would make in the face of disagreement.
Methods: Ambulatory patients in six clinics of internal medicine at a university hospital were surveyed using a self-administered questionnaire.
Results: A total of 307 patients participated in our survey. Of the respondents, 47% would accept recommendations made by physicians, even if such recommendations were against their wishes; 25% would try to persuade their physician to change their recommendations; and 14% would leave their physician to find a new one.
Seventy-six percent of the respondents thought that physicians should routinely ask patients if they would want to know about a diagnosis of cancer, while 5% disagreed; 59% responded that physicians should inform them of the actual diagnosis, even against the request of their family not to do so, while 24% would want their physician to abide by their family's request and 14% could not decide. One-third of the respondents who initially said they would want to know the truth would yield to the desires of the family in a case of disagreement.
Interpretations: In the face of disagreement regarding medical care and disclosure, Japanese patients tend to respond in a diverse and unpredictable manner. Medical professionals should thus be prudent and ask their patients explicitly what they want regarding medical care and information.     

Prenatal hemoglobinopathy screening. IV. Follow-up of women at risk for a child with a clinically significant hemoglobinopathy.

To determine the benefits and burdens of prenatal hemoglobinopathy carrier identification and genetic counseling and its impact on subsequent reproductive behavior, we recontacted women whom we had previously identified as at risk for having a child with a clinically significant hemoglobinopathy, regardless of whether they had accepted the offer of prenatal diagnosis. Of the 46 such women, 31 were available for interview. These 31 women had received offers of prenatal diagnosis in 47 pregnancies. Seventeen had been accepted, and 30 had been declined. The proportion of patients accepting the offer of prenatal diagnosis was higher for the index pregnancy (50%) than for subsequent pregnancies (22%). The mean interval between the initial counseling of the patient and the follow-up interview was 43 mo (standard error +/- 2.7 mo). Ninety-four percent of those interviewed recalled having received information from the screening program; 74% recalled the name of their condition; 90% knew that trait did not affect their health; 84% recalled the name of the condition for which their fetus had been at risk; and 77% could state at least one symptom of the disease. Of the 29 women asked whether they intended to use prenatal diagnosis in future pregnancies, 13 said yes and 16 said no. Of the 26 patients asked about satisfaction with their previous decision about prenatal diagnosis, all were satisfied with their decision. Eighteen said they would make the same decision in their next pregnancy, but seven patients said they would not, and one was undecided.(ABSTRACT TRUNCATED AT 250 WORDS)     

Constraints and heroes

A story, perhaps apocryphal, is told about the United States surgical team which pioneered the first artificial heart procedure. It is said that the team received a number of telephone calls from people around the country who, worried about the ailing heart recipient, offered to donate to him their own hearts. When the surgical team, justifiably curious, sent psychiatrists to examine these donors, they found to their surprise that many of the donors were rational, competent, sincere, and fully aware that as a consequence of donating their hearts they would die.... My concerns here will be threefold. First, I want to add some substance to the widely-held intuition that there is something morally objectionable about a physician participating in procedures which put even a willing subject at risk. In so doing, I want to explore the larger question of why such a puzzle arises -- why physicians, and many others, find it morally objectionable to help someone do something which all agree to be heroic. Finally, I will start by examining some ways of framing the issue, widely employed in medical ethics, which I believe are simply wrong. This sort of puzzle is much more interesting than proponents of these standard arguments would have us believe, and it illustrates some larger points about morality which are often overlooked.     

Medical students' attitudes toward genetic testing of minors

The purpose of this study was to examine attitudes of medical students at a single university toward genetic testing in minors, defining attitudes as willingness to offer testing, and reasons for offering or not offering testing. A survey was distributed to all University of Arizona medical students (n = 428) during the 2003-2004 academic year. The survey consisted of three clinical vignettes concerning genetic testing for Huntington's disease (HD), BRCA1 breast cancer predisposition mutation, and cystic fibrosis (CF) carrier status. For each vignette, students responded to whether they would provide testing for a 7-year-old, a 17-year-old, and their reasons for each age and condition. One hundred thirty-five students (31.5%) responded to the survey. Medical students were significantly more likely to test a 7-year-old for CF carrier status (57%), than they were for a BRCA1 mutation (47%), and an HD mutation (40%). Students were significantly more likely to test a 17-year-old than a 7-year-old in each clinical scenario. Students who had completed a genetics course in medical school were significantly less likely to test a 7-year-old for a BRCA1 mutation than those who had not completed a formal course. Medical students' willingness to perform genetic testing in a minor is influenced by the type of condition, the age of the minor being tested, and the amount of genetics education received in medical school.     

Reactions to children's faces: Resemblance affects males more than females

Since cuckoldry risk is asymmetrical, we hypothesized that parental investment would be more affected by paternal than maternal resemblance. To test this hypothesis, we asked subjects hypothetical questions about investing in children under conditions in which their faces or those of other people had been morphed with photographs of children. Males were more likely to choose a face they had been morphed with as the most attractive, the child they were most likely to adopt, the child they would like to spend the most time with, the child they would spend US$50 on, and the child they would least resent having to pay child support for. Reactions to children's faces by females were much less affected by resemblance.     

Risk and resiliency factors in posttraumatic stress disorder

BACKGROUND: Not everyone who experiences a trauma develops posttraumatic stress disorder (PTSD). The aim of this study was to determine the risk and resiliency factors for this disorder in a sample of people exposed to trauma. METHOD: Twenty-five people who had developed PTSD following a trauma and 27 people who had not were asked to complete the Posttraumatic Stress Diagnostic Scale, the Coping Inventory for Stressful Situations, and the State-Trait Anxiety Inventory. In addition, they completed a questionnaire to provide information autobiographic and other information. ANALYSIS: Five variables that discriminated significantly between the two groups using chi-square analysis or t-tests were entered into a logistic regression equation as predictors, namely, being female, perceiving a threat to one's life, having a history of sexual abuse, talking to someone about the event, and the "intentionality" of the trauma. RESULTS: Only being female and perceiving a threat to one's life were significant predictors of PTSD. Taking base rates into account, 96.0% of participants with PTSD were correctly classified as having the disorder and 37.0% of participants without PTSD were correctly classified as not having the disorder, for an overall success rate of 65.4% CONCLUSIONS: Because women are more likely than men to develop PTSD, more preventive measures should be directed towards them. The same is true for trauma victims (of both sexes) who feel that their life was in danger     

Mothers' experiences of induction

Mothers of a random sample of 2182 legitimate live births were interviewed about their experiences of pregnancy, labour, and delivery. Of these, 24% reported that their labours were induced, and data about this from a subsample of mothers tallied with information obtained through the doctors in charge in 88% of cases. All but 3% of the mothers who were induced perceived some medical reason for the induction. The proportion of inductions in the 24 study areas ranged from 6% to 39%. A relatively small proportion of labours in “teaching” hospitals, small hospitals with less than 100 beds, and GP maternity hospitals were induced, but a comparatively high proportion of private patients had an induction. There was no clear association between induction and the mother''s age or parity. Despite being given more pain relief, those who were induced reported similar intensities of pain during the first and second stages of labour to those whose labour started spontaneously; they also reported that they had “bad pains” for a similar period. The period they had contractions was shorter for the induced than for those starting spontaneously, and the intensity of pain at delivery was rated somewhat less by those who were induced.There was no difference between induced babies and others in the proportion who were held by their mothers immediately after their birth. Two-fifths of the mothers who were induced would have liked more information about induction; and a similar proportion said they had not discussed induction with a doctor, midwife, or nurse during their pregnancy. Only 17% of the mothers who had an induction said they would prefer to be induced if they had another baby. This contrasts with 63% of those who had epidural analgesia who would opt for the same procedure next time, while 83% of those who had had a baby in hospital, and 91% of those having had a home birth, would want their next baby in the same type of place.